The normal working hours of the company vary and encompass different shifts, including Saturdays. Without indicating the need for any absences for religious practices during the normal working hours, are you otherwise available to work during these hours?

YesNo

Date you could begin working *

How did you hear about us? *

Education

High School *

Address *

Last year completed *

Did you graduate?

YesNo

Diploma/Degree*

College

Address

Last year completed

Did you graduate?

YesNo

Diploma/Degree

Graduate

Address

Last year completed

Did you graduate?

YesNo

Diploma/Degree

Other

Address

Last year completed

Did you graduate?

YesNo

Diploma/Degree

Employment Record Please list most recent position first

Company *

Phone *

Address *

Supervisor *

Job Title or Duties *

Reason for Leaving *

Company

Phone

Address

Supervisor

Job Title or Duties

Reason for Leaving

Company

Phone

Address

Supervisor

Job Title or Duties

Reason for Leaving

Company

Phone

Address

Supervisor

Job Title or Duties

Reason for Leaving

Personal References Not former employers or relatives

Reference 1

Name *

Address

Phone *

Relationship and years known *

Reference 2

Name *

Address

Phone *

Relationship and years known *

Years of Experience

Laborer

YesNo

Years of Experience *

Rough Carpentry

YesNo

Years of Experience *

Iron Work

YesNo

Years of Experience *

Masonry

YesNo

Years of Experience *

Heavy Equipment

YesNo

Years of Experience *Type of equipment? *

CDL

YesNo

Years of Experience *Type of CDL?

Welding

YesNo

Years of Experience *Years of Flux Core ExperienceYears of Stick Experience

Dry Wall Finishing

YesNo

Years of Experience *

Concrete Finishing

YesNo

Years of Experience *

Flooring

YesNo

Years of Experience *

Finish Carpentry

YesNo

Years of Experience *

PLEASE READ THE LANGUAGE BELOW CAREFULLY. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS LANGUAGE, PLEASE SEEK ASSISTANCE PRIOR TO SIGNING THIS DOCUMENT.

I certify that the information contained in this application is true, accurate and complete. I understand that falsification of this Employment Application in any detail may result in disqualification from further consideration, or, if hired, immediate dismissal without notice from employment. As a condition of employment, I understand that Adena reserves the privilege to thoroughly investigate and verify all information contained in this Employment Application, including but not limited to contacting any of the aforementioned employers, supervisors and references. I agree to indemnify and save harmless Adena from and against any liabilities, claims, attorney fees, costs, causes of action or other liability arising directly or indirectly from, or associated with, this Employment Application.

I agree to conform to the rules and regulations of Adena, and I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either Adena or myself. I further understand that no personnel recruiter or interviewer other than an authorized representative of Adena, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

I have read and agree to the above conditions.

Equal Employment Opportunity Information

The information supplied below is strictly voluntary and will in no way affect the processing of your employment status with this company. This information sheet will only be used for statistical purposes. Thank you for your cooperation.

Sex

MaleFemalePrefer not to answer

Race

WHITE: Persons having origins in any of the original peoples of Europe or the Middle East.BLACK: Persons having origins in any of the black racial groups of Africa.HISPANIC: Persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.NATIVE AMERICAN OR ALASKAN NATIVE: Persons having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition.ASIAN/PACIFIC ISLANDERS: Persons having origins in any of the original peoples of the Far East, Southeast Asia, Indian Subcontinent or the Pacific Islands.

Disability

Are you an individual with a physical or mental impairment which substantially limits one or more of your major life activities?